MR Waiver by jay16344

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									Mental Retardation (MR) Waiver
   Local   National Modifier Code Description                                        FY 2004 Rate      FY 2005 Rate              FY 2006 Rate
   Code     Code                                                                                      0.35% Increase    3.00% Increase 5.00% Increase
Z8545     T1017      U3      Case Management                                         $260.00        $260.00            $260.00
Z8999     H2011              Crisis Stabilization - Intervention                     $81.00         $81.28             $83.43
Z8899     H0040              Crisis Stabilization - Supervision                      $22.00         $22.08             $22.66
Z8551     97535              Congregate Residential Support                          $12.81/hr      $12.85             $13.19
Z8595     H2014              In-Home Residential Support                             $18.00/hr      $18.06             $18.54
Z8597     H2023              Supported Employment, Individual Placed Prevocational   $16.00/hr      $16.06             $16.48
Z8598     H2024              Supported Employment, Enclave/Work Crew                 $32.50/hr      $32.61             $33.48
Z8556     97537              Day Support, Regular Intensity, Center Based            $23.99/unit    $24.07             $24.71
Z8557     97537      U1      Day Support, High Intensity, Center Based               $34.15/unit    $34.27             $35.17
Z8560     97537              Day Support, Regular Intensity, Non-Center Based        $23.99/unit    $24.07             $24.71
Z8561     97537      U1      Day Support, High Intensity, Non-Center Based           $34.15/unit    $34.27             $35.17
Z8565     97139              Therapeutic Consultation                                $50.00/hr      $50.18             $51.50
Z8600     S5165              Environmental Modifications Only                        IC             IC                 IC
Y0058     99199      U4      Environmental Modification, Maintenance Costs Only      IC             IC                 IC
Z8604     T1999              Assistive Technology Only                               IC             IC                 IC
Z8605     T1999      U5      Assistive Technology, Maintenance Costs Only            IC             IC                 IC
Z9401     T1002              Skilled Nursing Services/RN                             $30.00 N       $30.11             $30.90
                             (rate, N=NOVA, R=Rest of State)                         $24.70 R       $24.79             $25.44
Z9402     T1003              Skilled Nursing Services/LPN                            $26.00/hr N    $26.09             $26.78
                             (rate, N=NOVA, R=Rest of State)                         $21.45/hr R    $21.53             $22.09
Z4036     T1019              Personal Assistance                                     $13.38/hr N    $13.38                             $14.05
                             (rate, N=NOVA, R=Rest of State)                         $11.36/hr R    $11.36                             $11.93
Y0078     S5126              Consumer Directed Personal Assistance/Attendant Care    $10.10/hr N    $10.10                             $10.61
                             (rate, N=NOVA, R=Rest of State)                         $7.80/hr R     $7.80                              $8.19
Z9570     99199      U1      Criminal Record Check                                   $15.00         $15.00             $15.00
Z9568     S5116              Management Training                                     $26.00 N       $26.09             $26.78
                             (rate, N=NOVA, R=Rest of State)                         $20.00 R       $20.07             $20.60
Y0061     99199              CPS Registry Check                                      $5.00          $5.00              $5.00
Z9421     T1005              Respite Services                                        $13.38/hr N    $13.38                             $14.05
                             (rate, N=NOVA, R=Rest of State)                         $11.36/hr R    $11.36                             $11.93
**        S5136              Consumer Directed Companion Services                    $10.10/hr N    $10.10                             $10.61
                             (rate, N=NOVA, R=Rest of State)                         $7.80/hr R     $7.80                              $8.19
Y0064     S5150              Consumer-Directed Respite Services                      $10.10/hr N    $10.10                             $10.61
                             (rate, N=NOVA, R=Rest of State)                         $7.80/hr R     $7.80                              $8.19
Y0065     H2000              CD - Intitial Comprehensive Visit                       $209.00 N      $209.73            $215.27
                             (rate, N=NOVA, R=Rest of State)                         $161.00 R      $161.56            $165.83
Y0067     99509              CD - Routine Visit                                      $65.00 N       $65.23             $66.95
                             (rate, N=NOVA, R=Rest of State)                         $50.00 R       $50.18             $51.50
Y0066     S5109              Employee Management Training/Consumer Training          $208.00 N      $208.73            $214.24
                             (rate, N=NOVA, R=Rest of State)                         $160.00 R      $160.56            $164.80
Y0068     T1028              CD - Reassessment Visit                                 $105.00 N      $105.37            $108.15
                             (rate, N=NOVA, R=Rest of State)                         $80.00 R       $80.28             $82.40
Y0070     S5135              Companion Services                                      $13.38/hr N    $13.38                             $14.05
                             (rate, N=NOVA, R=Rest of State)                         $11.36/hr R    $11.36                             $11.93
Y0071     S5160              PERS Installation                                       $59.00 N       $59.00             $59.00
                             (rate, N=NOVA, R=Rest of State)                         $50.00 R       $50.00             $50.00
Y0072     S5160      U1      PERS and Medication Monitoring Installation             $88.50 N       $88.50             $88.50
                             (rate, N=NOVA, R=Rest of State)                         $75.00 R       $75.00             $75.00
Y0073     S5161              PERS Monitoring                                         $34.50 N       $34.50             $34.50
                             (rate, N=NOVA, R=Rest of State)                         $30.00 R       $30.00             $30.00
Y0074     S5185              PERS and Medication Monitoring                          $59.00 N       $59.00             $59.00
                             (rate, N=NOVA, R=Rest of State)                         $50.00 R       $50.00             $50.00
Y0075     H2021      TD      PERS Nursing Services/RN                                $15.00 N       $15.00             $15.00
                             (rate, N=NOVA, R=Rest of State)                         $12.25 R       $12.25             $12.25
Y0076     H2021      TE      PERS Nursing Services/LPN                               $13.00 N       $13.00             $13.00
                             (rate, N=NOVA, R=Rest of State)                         $10.25 R       $10.25             $10.25
**        H2025              Pre-vocational Services, Regular Intensity              $23.99/unit    $24.07             $24.71
**        H2025      U1      Pre-vocational Services, High Intensity                 $34.15/unit    $34.27             $35.17
Individuals and Families Developmental Disability Services (DD) Waiver
  Local    National Modifier Code Description                                              FY 2004 Rate     FY 2005 Rate           FY 2006 Rate
  Code       Code                                                                                          0.35% Increase 3.00% Increase 5.00% Increase
Y0055    H0046                Support Coordination                                        $175.40/mo      $175.40         $175.40
         T2023                Support Coordination/ est. 4.22.2004; effective 6.20.2003
Y0056    H2011                Crisis Stabilization - Intervention                         $81.00/hr       $81.28         $83.43
Y0057    H0040                Crisis Stabilization - Supervision                          $22.00/hr       $22.08         $22.66
Z8595    H2014                In-Home Residential Support                                 $18.00/hr       $18.06         $18.54
Z8597    H2023                Supported Employment, Individual Placement                  $16.00/hr       $16.06         $16.48
Z8598    H2024                Supported Employment, Enclave/Work Crew                     $32.50/unit     $32.61         $33.48
Z8556    97537                Day Support, Regular Intensity, Center Based                $23.99/unit     $24.07         $24.71
Z8557    97537      U1        Day Support, High Intensity, Center Based                   $34.15/unit     $34.27         $35.17
Z8560    97537                Day Support, Regular Intensity, Non-Center Based            $23.99/unit     $24.07         $24.71
Z8561    97537      U1        Day Support, High Intensity, Non-Center Based               $34.15/unit     $34.27         $35.17
Z8565    97139                Therapeutic Consultation                                    $50.00/hr       $50.18         $51.50
Z8600    S5165                Environmental Modification                                  IC              IC             IC
Y0058    99199      U4        Environmental Modification, Maintenance Costs Only          IC              IC             IC
Z8604    T1999                Assistive Technology                                        IC              IC             IC
Z8605    T1999      U5        Assistive Technology, Maintenance Costs Only                IC              IC             IC
Y0059    T1002                Nursing Services/RN                                         $30.00/hr N     $30.11         $30.90
                              (rate, N=NOVA, R=Rest of State)                             $24.70/hr R     $24.79         $25.44
Y0060    T1003                Nursing Services/LPN                                        $26.00/hr N     $26.09         $26.78
                              (rate, N=NOVA, R=Rest of State)                             $21.45/hr R     $21.53         $22.09
Z4036    T1019                Personal Care                                               $13.38/hr N     $13.38                         $14.05
                              (rate, N=NOVA, R=Rest of State)                             $11.36/hr R     $11.36                         $11.93
Y0078    S5126                CD Personal Assistance/Attendant Care                       $10.10/hr N     $10.10                         $10.61
                              (rate, N=NOVA, R=Rest of State)                             $7.80/hr R      $7.80                          $8.19
Y0064    S5150                Consumer Directed Respite                                   $10.10/hr N     $10.10                         $10.61
                              (rate, N=NOVA, R=Rest of State)                             $7.80/hr R      $7.80                          $8.19
**       S5136                Consumer Directed Companion Services                        $10.10/hr N     $10.10                         $10.61
                              (rate, N=NOVA, R=Rest of State)                             $7.80/hr R      $7.80                          $8.19
Y0062    H2000                CD - Intitial Comprehensive Visit                           $209.00 N       $209.73        $215.27
Y0065                         (rate, N=NOVA, R=Rest of State)                             $161.00 R       $161.56        $165.83
Y0063    S5109                Consumer Training                                           $208.00 N       $208.73        $214.24
Y0066                         (rate, N=NOVA, R=Rest of State)                             $160.00R        $160.56        $164.80
Z9562    99509                Routine Home Visit                                          $65.00 N        $65.23         $66.95
Y0067                         (rate, N=NOVA, R=Rest of State)                             $50.00 R        $50.18         $51.50
Z9570    99199      U1        Criminal Record Check                                       $15.00          $15.00         $15.00
Z9564    T1028                Reassessment Visit                                          $105.00 N       $105.37        $108.15
Y0068                         (rate, N=NOVA, R=Rest of State)                             $80.00 R        $80.28         $82.40
Z9568    S5116                Management Training                                         $26.00 N        $26.09         $26.78
                              (rate, N=NOVA, R=Rest of State)                             $20.00 R        $20.07         $20.60
Z8811    99080                Fiscal Agent Services (DMAS ONLY)                           $17.42/chec     $17.42         $17.42
Y0069
Y0061    99199                CPS Registry Check                                          $5.00           $5.00          $5.00
Z9421    T1005                Respite Care                                                $13.38/hr N     $13.38                         $14.05
                              (rate, N=NOVA, R=Rest of State)                             $11.36/hr R     $11.36                         $11.93
Y0070    S5135                Companion Care                                              $13.38 N        $13.38                         $14.05
                              (rate, N=NOVA, R=Rest of State)                             $11.36 R        $11.36                         $11.93
Y0071    S5160                PERS Installation                                           $59.00 N        $59.00         $59.00
                              (rate, N=NOVA, R=Rest of State)                             $50.00 R        $50.00         $50.00
Y0072    S5160      U1        PERS and Medication Monitoring Installation                 $88.50 N        $88.50         $88.50
                              (rate, N=NOVA, R=Rest of State)                             $75.00 R        $75.00         $75.00
Y0073    S5161                PERS Monitoring                                             $35.40 N        $35.40         $35.40
                              (rate, N=NOVA, R=Rest of State)                             $30.00 R        $30.00         $30.00
Y0074    S5185                PERS and Medication Monitoring                              $59.00 N        $59.00         $59.00
                              (rate, N=NOVA, R=Rest of State)                             $50.00 R        $50.00         $50.00
Y0075    H2021      TD        PERS Nursing Services/RN                                    $15.00 N        $15.00         $15.00
                              (rate, N=NOVA, R=Rest of State)                             $12.25 R        $12.25         $12.25
Y0076    H2021      TE        PERS Nursing Services/LPN                                   $13.00 N        $13.00         $13.00
                              (rate, N=NOVA, R=Rest of State)                             $10.25 R        $10.25         $10.25
**       H2025                Pre-vocational Services, Regular Intensity                  $23.99/unit     $24.07         $24.71
**       H2025      U1        Pre-vocational Services, High Intensity                     $34.14/unit     $34.26         $35.16
Y0077    S5111                Family Care Giver Training                                  $42.50/hr       $42.65         $43.78
Day Support Waiver
  Local   National   Modifier Code Description                                   FY 2004 Rate    FY 2005 Rate                FY 2006 Rate
  Code      Code                                                                                0.35% Increase     3.00% Increase    5.00% Increase
         97537                Day Support, Regular Intensity, Center Based       $23.99/unit                     $24.71
         97537       U1       Day Support, High Intensity, Center Based          $34.15/unit                     $35.17
         97537                Day Support, Regular Intensity, Non-Center Based   $23.99/unit                     $24.71
         97537       U1       Day Support, High Intensity, Non-Center Based      $34.15/unit                     $35.17
         H2025                Pre-vocational Services, Regular Intensity         $23.99/unit                     $24.71
         H2025       U1       Pre-vocational Services, High Intensity            $34.15/unit                     $35.17
HIV/AIDS Waiver
 Local    National   Modifier Code Description                        FY 2004 Rate     FY 2005 Rate              FY 2006 Rate
  Code     Code                                                                       0.35% Increase    3.00% Increase 5.00% Increase
Z9401   T1002                 Nursing Services/RN                     $30.00/hr N    $30.00            $30.00
                              (rate, N=NOVA, R=Rest of State)         $24.70/hr R    $24.70            $24.70
Z9402   T1003                 Nursing Services/LPN                    $26.00/hr N    $26.00            $26.00
                              (rate, N=NOVA, R=Rest of State)         $21.45/hr R    $21.45            $21.45
Z4035   T1019                 Personal Care                           $14.39/hr N    $14.39                            $15.11
                              (rate, N=NOVA, R=Rest of State)         $12.68/hr R    $12.68                            $13.31
Y0078   S5126                 CD Personal Assistance/Attendant Care   $10.10/hr N    $10.10                            $10.61
                              (rate, N=NOVA, R=Rest of State)         $7.80/hr R     $7.80                             $8.19
Y0064   S5150                 Consumer Directed Respite               $10.10/hr N    $10.10                            $10.61
                              (rate, N=NOVA, R=Rest of State)         $7.80/hr R     $7.80                             $8.19
Y0062   H2000                 CD - Intitial Comprehensive Visit       $209.00 N      $209.73           $215.27
Y0065                         (rate, N=NOVA, R=Rest of State)         $161.00 R      $161.56           $165.83
Y0063   S5109                 Consumer Training                       $208.00 N      $208.73           $214.24
Y0066                         (rate, N=NOVA, R=Rest of State)         $160.00R       $160.56           $164.80
Z9562   99509                 Routine Home Visit                      $65.00 N       $65.23            $66.95
Y0067                         (rate, N=NOVA, R=Rest of State)         $50.00 R       $50.18            $51.50
Z9570   99199        U1       Criminal Record Check                   $15.00         $15.00            $15.00
Z9564   T1028                 Reassessment Visit                      $105.00 N      $105.37           $108.15
Y0068                         (rate, N=NOVA, R=Rest of State)         $80.00 R       $80.28            $82.40
Z9568   S5116                 Management Training                     $26.00 N       $26.09            $26.78
                              (rate, N=NOVA, R=Rest of State)         $20.00 R       $20.07            $20.60
Y0061   99199                 CPS Registry Check                      $5.00          $5.00             $5.00
Z9421   T1005                 Respite Care                            $14.39/hr N    $14.39                            $15.11
                              (rate, N=NOVA, R=Rest of State)         $12.68/hr R    $12.68                            $13.31
Z9404   S9125        TE       Respite Care/LPN                        $26.00/hr N    $26.00                            $27.30
                              (rate, N=NOVA, R=Rest of State)         $21.45/hr R    $21.45                            $22.52
Z9403   S9125        TD       Respite Care/RN                         $30.00/hr N    $30.00                            $31.50
                              (rate, N=NOVA, R=Rest of State)         $24.70/hr R    $24.70                            $25.94
Z9440   T1016                 Case Management                         $20.00/hr N    $20.00            $20.00
                              (rate, N=NOVA, R=Rest of State)         $15.00/hr R    $15.00            $15.00
Elderly or Disabled with Consumer Direction Waiver
 Local     National Modifier Code Description                               FY 2004 Rate     FY 2005 Rate              FY 2006 Rate
  Code       Code                                                                           0.35% Increase    3.00% Increase 5.00% Increase
Z4036    T1019                Personal Assistance                           $13.38/hr N    $13.38                            $14.05
                              (rate, N=NOVA, R=Rest of State)               $11.36/hr R    $11.36                            $11.93
Z9421    T1005                Respite Care/Aide                             $13.38/hr N    $13.38                            $14.05
                              (rate, N=NOVA, R=Rest of State)               $11.36/hr R    $11.36                            $11.93
Z9423    S9125                Respite Care/LPN                              $26.00/hr N    $26.00                            $27.30
                              (rate, N=NOVA, R=Rest of State)               $21.45/hr R    $21.45                            $22.52
Y0078    S5126                CD Personal Assistance/Attendant Care         $10.10/hr N    $10.10                            $10.61
                              (rate, N=NOVA, R=Rest of State)               $7.80/hr R     $7.80                             $8.19
Y0064    S5150                Consumer Directed Respite                     $10.10/hr N    $10.10                            $10.61
                              (rate, N=NOVA, R=Rest of State)               $7.80/hr R     $7.80                             $8.19
Y0062    H2000                CD - Intitial Comprehensive Visit             $209.00 N      $209.73           $215.27
Y0065                         (rate, N=NOVA, R=Rest of State)               $161.00 R      $161.56           $165.83
Y0063    S5109                Consumer Training                             $208.00 N      $208.73           $214.24
Y0066                         (rate, N=NOVA, R=Rest of State)               $160.00R       $160.56           $164.80
Z9562    99509                Routine Home Visit                            $65.00 N       $65.23            $66.95
Y0067                         (rate, N=NOVA, R=Rest of State)               $50.00 R       $50.18            $51.50
Z9564    T1028                Reassessment Visit                            $105.00 N      $105.37           $108.15
Y0068                         (rate, N=NOVA, R=Rest of State)               $80.00 R       $80.28            $82.40
Z9568    S5116                Management Training                           $26.00 N       $26.09            $26.78
                              (rate, N=NOVA, R=Rest of State)               $20.00 R       $20.07            $20.60
Z9570    99199       U1       Criminal Record Check                         $15.00         $15.00            $15.00
Y0061    99199                CPS Registry Check                            $5.00          $5.00             $5.00
Z9410    S5102                Adult Day Health Care                         $47.25/hr N    $47.25            $47.25
                              (rate, N=NOVA, R=Rest of State)               $43.05/hr R    $43.05            $43.05
Z9412    A0120                Adult Day Health Care Transportation          $2.00/trip     $2.00             $2.00
Y0071    S5160                PERS Installation                             $59.00 N       $59.00            $59.00
                              (rate, N=NOVA, R=Rest of State)               $50.00 R       $50.00            $50.00
Y0072    S5160       U1       PERS and Medication Monitoring Installation   $88.50 N       $88.50            $88.50
                              (rate, N=NOVA, R=Rest of State)               $75.00 R       $75.00            $75.00
Y0073    S5161                PERS Monitoring                               $34.50 N       $34.50            $34.50
                              (rate, N=NOVA, R=Rest of State)               $30.00 R       $30.00            $30.00
Y0074    S5185                PERS and Medication Monitoring                $59.00 N       $59.00            $59.00
                              (rate, N=NOVA, R=Rest of State)               $50.00 R       $50.00            $50.00
Y0075    H2021       TD       PERS Nursing Services/RN                      $15.00 N       $15.00            $15.00
                              (rate, N=NOVA, R=Rest of State)               $12.25 R       $12.25            $12.25
Y0076    H2021       TE       PERS Nursing Services/LPN                     $13.00 N       $13.00            $13.00
                              (rate, N=NOVA, R=Rest of State)               $10.25 R       $10.25            $10.25
          COMMUNITY BASED CARE RATE HISTORY, STATE FISCAL YEARS

Procedu
re Code                 Service                                   Waivers                         Unit             1982-88
 S5135    Adult Companion Care – Agency                       Mental Retardation;                 Hour
                                                           Developmental Disabilities
S5135     Adult Companion Care – Agency                       Mental Retardation.                 Hour
          NOVA                                             Developmental Disabilities
S5136     Adult Companion Care – Consumer                      Mental Retardation                 Hour
          Directed
S5136     Adult Companion Care – Consumer                      Mental Retardation                 Hour
          Directed NOVA
S5102     Adult Day Health Care                               Elderly and Disabled                Day
S5102     Adult Day Health Care NOVA                          Elderly and Disabled                Day
T1999     Assistive Technology                                Mental Retardation;        Reimb at Cost, $5,000
                                                           Developmental Disabilities;         max/yr
                                                             Technology Assisted
97535     Congregate Residential                              Mental Retardation                  Hour
S5165     Environmental Modifications                         Mental Retardation;        Reimb at Cost, $5,000
                                                           Developmental Disabilities;         max/yr
                                                             Technology Assisted

T1016     Case Management - AIDS                                     AIDS                         Hour
T1016     Case Management - AIDS NOVA                                AIDS                         Hour
T1017     Case Management - MR                                     State Plan                    Month
          Support Coordination - DD                                State Plan                    Month
H2011     Crisis Intervention                                 Mental Retardation;                 Hour
                                                           Developmental Disabilities
H2011     Crisis Stabilization                                Mental Retardation;                 Hour
                                                           Developmental Disabilities
97537     Day Support Regular, Center Based                   Mental Retardation;        Unit (One Unit=1 to 3.9
                                                           Developmental Disabilities    Hours. Two Units=4 to
                                                                                           6.9 Hours. Three
                                                                                         Units=7 or more hours
                                                                                                per day)
97537     Day Support Regular, Non-Center Based               Mental Retardation;        Unit (One Unit=1 to 3.9
          (rates before 1999 reflect State Plan Service,   Developmental Disabilities    Hours. Two Units=4 to
          Day Health and Rehab. Eliminated by CMS in                                       6.9 Hours. Three
          1999)                                                                          Units=7 or more hours
                                                                                                per day)
97537     Day Support High Intensity, Center                  Mental Retardation;        Unit (One Unit=1 to 3.9
          Based                                            Developmental Disabilities    Hours. Two Units=4 to
                                                                                           6.9 Hours. Three
                                                                                         Units=7 or more hours
                                                                                                per day)
97537     Day Support High Intensity, Non-Center              Mental Retardation;        Unit (One Unit=1 to 3.9
          Based                                            Developmental Disabilities    Hours. Two Units=4 to
                                                                                           6.9 Hours. Three
                                                                                         Units=7 or more hours
                                                                                                per day)
S5111    Family/Caregiver Training              Developmental Disabilities        Hour
H2014    In-Home Residential                       Mental Retardation;            Hour
                                                Developmental Disabilities
Varies   Nutritional Supplements                         AIDS                  Price Varies
T1019    Personal Care – Agency                 Elderly and Disabled with          Hour       $7.00
                                               Consumer Direction; Mental
                                               Retardation; Developmental
                                              Disabilities; AIDS; Technology
                                                          Assisted
T1019    Personal Care – Agency NOVA            Elderly and Disabled with         Hour        $7.00
                                               Consumer Direction; Mental
                                               Retardation; Developmental
                                              Disabilities; AIDS; Technology
                                                          Assisted
S5126    Personal Care – Consumer Directed      Elderly and Disabled with         Hour
                                               Consumer Direction; Mental
                                               Retardation; Developmental
                                                    Disabilities; AIDS
S5126    Personal Care – Consumer Directed      Elderly and Disabled with         Hour
         NOVA                                  Consumer Direction; Mental
                                               Retardation; Developmental
                                                    Disabilities; AIDS

S5160    Personal Emergency Response System     Elderly and Disabled with      Installation
         (PERS) Installation                   Consumer Direction; Mental
                                               Retardation; Developmental
                                                       Disabilities
S5160    Personal Emergency Response System     Elderly and Disabled with      Installation
         (PERS) Installation NOVA              Consumer Direction; Mental
                                               Retardation; Developmental
                                                       Disabilities
S5160    Personal Emergency Response System     Elderly and Disabled with      Installation
         (PERS) and Med Monitoring             Consumer Direction; Mental
                                               Retardation; Developmental
         Installation                                  Disabilities
S5160    Personal Emergency Response System     Elderly and Disabled with      Installation
         (PERS) and Med Monitoring             Consumer Direction; Mental
                                               Retardation; Developmental
S5161    Installation NOVA Response System
         Personal Emergency                     Elderly and Disabled with        Month
         (PERS) Monitoring                     Consumer Direction; Mental
                                               Retardation; Developmental
                                                       Disabilities
S5161    Personal Emergency Response System     Elderly and Disabled with        Month
         (PERS) Monitoring NOVA                Consumer Direction; Mental
                                               Retardation; Developmental
                                                       Disabilities
S5185    Personal Emergency Response System     Elderly and Disabled with        Month
         (PERS) and Med Monitoring             Consumer Direction; Mental
                                               Retardation; Developmental
                                                       Disabilities
S5185    Personal Emergency Response System     Elderly and Disabled with        Month
         (PERS) and Med Monitoring NOVA        Consumer Direction; Mental
                                               Retardation; Developmental
                                                       Disabilities
H2021   Personal Emergency Response System     Elderly and Disabled with      Contact (15 Minutes)
        (PERS) Nursing Services RN            Consumer Direction; Mental
                                              Retardation; Developmental
                                                      Disabilities
H2021   Personal Emergency Response System     Elderly and Disabled with      Contact (15 Minutes)
        (PERS) Nursing Services RN NOVA       Consumer Direction; Mental
                                              Retardation; Developmental
                                                      Disabilities
H2021   Personal Emergency Response System     Elderly and Disabled with      Contact (15 Minutes)
        (PERS) Nursing Services LPN           Consumer Direction; Mental
                                              Retardation; Developmental
                                                      Disabilities
H2021   Personal Emergency Response System     Elderly and Disabled with      Contact (15 Minutes)
        (PERS) Nursing Services LPN NOVA      Consumer Direction; Mental
                                              Retardation; Developmental
                                                      Disabilities
T1002   Private Duty Nursing-RN               AIDS; Technology Assisted              Hour
T1002   Private Duty Nursing-RN NOVA          AIDS; Technology Assisted              Hour
T1003   Private Duty Nursing-LPN              AIDS; Technology Assisted              Hour
T1003   Private Duty Nursing-LPN NOVA         AIDS; Technology Assisted              Hour

T1005   Respite Care - Agency                  Elderly and Disabled with             Hour
                                              Consumer Direction; Mental
                                              Retardation; Developmental
                                             Disabilities; AIDS; Technology
                                                         Assisted
T1005   Respite Care - Agency NOVA             Elderly and Disabled with             Hour
                                              Consumer Direction; Mental
                                              Retardation; Developmental
                                             Disabilities; AIDS; Technology
                                                         Assisted
S5150   Respite Care - Consumer Directed       Elderly and Disabled with             Hour
                                              Consumer Direction; Mental
                                              Retardation; Developmental
                                                   Disabilities; AIDS
S5150   Respite Care - Consumer Directed       Elderly and Disabled with             Hour
        NOVA                                  Consumer Direction; Mental
                                              Retardation; Developmental
                                                   Disabilities; AIDS
T1002   Skilled Nursing –RN                       Mental Retardation;                Hour
                                              Developmental Disabilities
T1002   Skilled Nursing –RN NOVA                  Mental Retardation;                Hour
                                              Developmental Disabilities
T1003   Skilled Nursing - LPN                     Mental Retardation;                Hour
                                              Developmental Disabilities
T1003   Skilled Nursing - LPN NOVA                Mental Retardation;                Hour
                                              Developmental Disabilities
H2023   Supported Employment- Individual          Mental Retardation;                Hour
                                              Developmental Disabilities
H2024   Supported Employment –Enclave             Mental Retardation;                Hour
                                              Developmental Disabilities
97139   Therapeutic Consultation                  Mental Retardation;                Hour
                                              Developmental Disabilities
L YEARS


          1989   1990   1991      1992      1993      1994      1995      1996      1997      1998




                                $25.00    $25.00    $25.00    $25.00    $28.00    $28.00    $28.00
                                $28.00    $28.00    $28.00    $28.00    $33.00    $33.00    $33.00



                                $12.50    $12.50    $12.50    $12.50    $12.50    $12.50    $12.50




                                $15.00   $15.00     $15.00    $15.00    $15.00    $15.00    $15.00
                                $20.00   $20.00     $20.00    $20.00    $20.00    $20.00    $20.00
                               $175.40   $175.40   $175.40   $175.40   $175.40   $175.40   $175.40




                               $20.00    $20.00    $22.50    $22.50    $22.50    $22.50    $22.50




                               $32.50    $32.50    $32.50    $32.50    $32.50    $32.50    $32.50




                               $20.00    $20.00    $22.50    $22.50    $22.50    $22.50    $22.50




                               $32.50    $32.50    $32.50    $32.50    $32.50    $32.50    $32.50
$8.00   $8.00   $8.00   $9.00    $9.00    $9.00    $9.00    $9.50    $9.50    $9.50




$8.50   $8.50   $9.50   $11.00   $11.00   $11.00   $11.00   $11.50   $11.50   $11.50




                                                                     $6.00    $6.00



                                                                     $8.25    $8.25
$21.60   $21.60   $24.70   $24.70   $24.70   $24.70   $24.70
$30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00
$19.00   $19.00   $21.45   $21.45   $21.45   $21.45   $21.45
$26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00

$9.00    $9.00    $9.00    $9.00    $9.50    $9.50    $9.50




$11.00   $11.00   $11.00   $11.00   $11.50   $11.50   $11.50




                           $24.70   $24.70   $24.70   $24.70

                           $30.00   $30.00   $30.00   $30.00

                           $21.45   $21.45   $21.45   $21.45

                           $26.00   $26.00   $26.00   $26.00

                           $16.00   $16.00   $16.00   $16.00

                           $32.50   $32.50   $32.50   $32.50

$50.00   $50.00   $50.00   $50.00   $50.00   $50.00   $50.00
                                                  M. Lupien 4/05




   1999     2000      2001      2002      2003       2004          2005       2006
           $11.25    $11.25    $11.25    $11.36      $11.36        $11.36     $11.36
                                                                                        1
           $13.25    $13.25    $13.25    $13.38      $13.38         $13.38    $13.38
                                                                                        2
                                $7.75     $7.80        $7.80         $7.80     $7.80
                                                                                        3
                               $10.00    $10.10      $10.10         $10.10    $10.10
                                                                                        4
 $34.50    $41.00    $41.00    $41.00    $41.00      $43.05         $43.05    $43.05    5
 $39.50    $45.00    $45.00    $45.00    $45.00      $47.25         $47.25    $47.25    6


                                                                                        7
 $12.50    $12.81    $12.81    $12.81    $12.81      $12.81         $12.85    $13.19    8



                                                                                        9
 $15.00   $15.00    $15.00     $15.00   $15.00      $15.00      $15.00        $15.00   10
 $20.00   $20.00    $20.00     $20.00   $20.00      $20.00      $20.00        $20.00   11
$175.40   $175.40   $175.40   $260.00   $260.00    $260.00     $260.00       $326.50   12
          $175.40   $175.40   $175.40   $175.40    $175.40     $175.40       $175.40   13
          $81.00    $81.00     $81.00   $81.00      $81.00      $81.28        $83.43
                                                                                       14

          $22.00    $22.00    $22.00    $22.00     $22.00          $22.08    $22.66    15
$23.99    $23.99    $23.99    $23.99    $23.99     $23.99          $24.07    $24.71


                                                                                       16
$23.99    $23.99    $23.99    $23.99    $23.99     $23.99          $24.07    $24.71


                                                                                       17
$34.15    $34.15    $34.15    $34.15    $34.15     $34.15          $34.27    $35.17


                                                                                       18
$34.15    $34.15    $34.15    $34.15    $34.15     $34.15          $34.27    $35.17



                                                                                       19
         $42.50   $42.50   $42.50   $42.50   $42.50   $42.65   $43.78   20
         $18.00   $18.00   $18.00   $18.00   $18.00   $18.06   $18.54
                                                                        21
                                                                        22
$10.50   $10.50   $11.25   $11.25   $11.36   $11.36   $11.36   $11.93



                                                                        23
$12.50   $12.50   $13.25   $13.25   $13.38   $13.38   $13.38   $14.05



                                                                        24
$6.00    $6.00    $7.75    $7.75    $7.80    $7.80    $7.80    $7.80


                                                                        25
$8.25    $8.25    $10.00   $10.00   $10.10   $10.10   $10.10   $10.10


                                                                        26
                           $50.00   $50.00   $50.00   $50.18   $50.18

                                                                        27
                           $59.00   $59.00   $59.00   $59.21   $59.21

                                                                        28
                           $75.00   $75.00   $75.00   $75.26   $75.26

                                                                        29
                           $88.50   $88.50   $88.50   $88.81   $88.81
                                                                        30
                           $30.00   $30.00   $30.00   $30.00   $30.00

                                                                        31
                           $35.40   $35.40   $35.40   $35.40   $35.40

                                                                        32
                           $50.00   $50.00   $50.00   $50.00   $50.00

                                                                        33
                           $59.00   $59.00   $59.00   $59.00   $59.00

                                                                        34
                           $12.25   $12.25   $12.25   $12.25   $12.25

                                                                        35
                           $15.00   $15.00   $15.00   $15.00   $15.00

                                                                        36
                           $10.25   $10.25   $10.25   $10.25   $10.25

                                                                        37
                           $13.00   $13.00   $13.00   $13.00   $13.00

                                                                        38
$24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.79   $25.44   39
$30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.11   $30.90   40
$21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.53   $22.09   41
$26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.09   $26.78
                                                                        42
$10.50   $10.50   $11.25   $11.25   $11.36   $11.36   $11.36   $11.93



                                                                        43
$12.50   $12.50   $13.25   $13.25   $13.38   $13.38   $13.38   $14.05



                                                                        44
                           $7.75    $7.80    $7.80    $7.80    $7.80


                                                                        45
                           $10.00   $10.10   $10.10   $10.10   $10.10

                                                                        46
$24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.79   $25.44
                                                                        47
$30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.11   $30.90
                                                                        48
$21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.53   $22.09
                                                                        49
$26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.09   $26.78
                                                                        50
$16.00   $16.00   $16.00   $16.00   $16.00   $16.00   $16.06   $16.48
                                                                        51
$32.50   $32.50   $32.50   $32.50   $32.50   $32.50   $32.61   $33.48
                                                                        52
$50.00   $50.00   $50.00   $50.00   $50.00   $50.00   $50.18   $51.50
                                                                        53
Attachment B: VA HCBS: SERVICE RATE HISTORY



                                                     Northern                                                                                                                                                                                                                                            January 1st 2007
                                                     Va                                                                                                                                                                                                                                                   Appropriations
                                                                Waivers                                                                                                                                                                                                   2006 after
                                                     (NOVA)                                                                                                                                                                                                                              July 1st 2006     Act (effects
National                                                        (See                              1982-                                                                                                                                                                    May Fist                                       Local
         Code Description                            and Rest                      Unit                   1989    1990     1991     1992     1993     1994     1995     1996     1997     1998     1999     2000     2001     2002     2003     2004     2005     2006                  Appropriations   adult day health
Code                                                 of State
                                                                Index at                           88                                                                                                                                                                      Increase                                       code
                                                                                                                                                                                                                                                                                              Act         only, catch up
                                                     (ROS)      Bottom)                                                                                                                                                                                                     (KKK)
                                                                                                                                                                                                                                                                                                          with a personal
                                                     rates                                                                                                                                                                                                                                                care increase)

S5102    Adult Day Health Care                       NOVA       3                   Day                          $28.00   $28.00   $28.00   $28.00   $28.00   $28.00   $33.00   $33.00   $33.00   $45.00   $45.00   $45.00   $45.00   $45.00   $47.25   $47.25   $47.25   $48.20       $48.20            $50.61          Z9410

S5102    Adult Day Health Care                       ROS        3                   Day                          $25.00   $25.00   $25.00   $25.00   $25.00   $25.00   $28.00   $28.00   $28.00   $41.00   $41.00   $41.00   $41.00   $41.00   $43.05   $43.05   $43.05   $43.91       $43.91            $46.11          Z9410
                                                                                Indivdual
T1999    Assistive Technology                                   4             Consideration                                                                   IC       IC       IC       IC       IC       IC       IC       IC       IC       IC       IC       IC       IC           IC                IC              Z8604
                                                                                   (IC)

H0023    Behavioral Health Outreach                             State Plan        Month                                                                                                                             IC       IC       IC       $260.00 $260.00 $326.50 $326.50         $326.50           $326.50


T1016    Case Management - AIDS                      NOVA       5                  Hour                                   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00       $20.00            $20.00          Z9440

T1016    Case Management - AIDS                      ROS        5                  Hour                                   $15.00   $15.00   $15.00   $15.00   $15.00   $15.00   $15.00   $15.00   $15.00   $15.00   $15.00   $15.00   $15.00   $15.00   $15.00   $15.00   $15.00       $15.00            $15.00          Z9440
                                                                                Vist. Limit
H2000    CD - Intitial Comprehensive Visit           NOVA       3                                                                                                                        $209.00 $209.00 $209.00 $209.00 $209.00 $209.00 $209.00 $209.73 $219.45 $219.45               $219.45           $219.45         Z9560
                                                                              one initial visit
                                                                                Vist. Limit
H2000    CD - Intitial Comprehensive Visit           ROS        3                                                                                                                        $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.56 $169.05 $169.05               $169.05           $169.05         Z9560
                                                                              one initial visit
                                                                                Vist. Limit
99509    CD - Routine Visit                          NOVA       3                                                                                                                                                   $65.00   $65.00   $65.00   $65.00   $65.23   $68.25   $68.25       $68.25            $68.25          Y0067
                                                                               once a month
                                                                                Vist. Limit
99509    CD - Routine Visit                          ROS        3                                                                                                                                                   $50.00   $50.00   $50.00   $50.00   $50.18   $52.50   $52.50       $52.50            $52.50          Y0067
                                                                               once a month
S5135    Companion Services                          NOVA       1, 2, 3,5,6        Hour                                                                                                                    $13.25   $13.25   $13.25   $13.25   $13.38   $13.38   $14.05   $14.33       $14.33            $14.33          Y0070

S5135    Companion Services                          ROS        1, 2, 3,5,6        Hour                                                                                                                    $11.25   $11.25   $11.25   $11.25   $11.36   $11.36   $11.93   $12.17       $12.17            $12.17          Y0070

S9122    Congregate - Aide                           NOVA       4                  Hour                                                              $10.00   $10.00   $10.00   $10.00   $10.00   $10.00   $10.00   $10.00   $10.00   $10.00   $10.45   $10.45   $10.97   $11.19       $11.19            $11.19          Z4037

S9122    Congregate - Aide                           ROS        4                  Hour                                                              $9.05    $9.05    $9.05    $9.05    $9.05    $9.05    $9.05    $9.05    $9.05    $9.05    $9.14    $9.14    $9.60    $9.79        $9.79             $9.79           Z4037

S9122    Congregate - Aide-AIDS                      NOVA       5                  Hour                                                              $10.00   $10.00   $10.00   $10.00   $10.00   $10.00   $10.00   $10.00   $10.00   $10.00   $10.10   $10.10   $10.97   $11.19       $11.19            $11.19          Z4037

S9122    Congregate - Aide-AIDS                      ROS        5                  Hour                                                              $9.05    $9.05    $9.05    $9.05    $9.05    $8.75    $8.75    $8.75    $8.75    $8.75    $8.84    $8.84    $9.60    $9.79        $9.79             $9.79           Z4037

T1031    Congregate Nursing Service, LPN             NOVA       4                  Hour                                                              $18.00   $18.00   $18.00   $18.00   $18.00   $18.00   $18.00   $18.00   $18.00   $18.00   $18.00   $18.00   $18.00   $18.00       $18.90            $18.90          Z9406

T1031    Congregate Nursing Service, LPN             ROS        4                  Hour                                                              $15.73   $15.73   $15.73   $15.73   $15.73   $15.73   $15.73   $15.73   $15.73   $15.73   $15.73   $15.73   $15.73   $15.73       $16.52            $16.52          Z9406

T1030    Congregate Nursing Service, RN              NOVA       4                  Hour                                                              $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00       $21.00            $21.00          Z9405

T1030    Congregate Nursing Service, RN              ROS        4                  Hour                                                              $17.35   $17.35   $17.35   $17.35   $17.35   $17.35   $17.35   $17.35   $17.35   $17.35   $17.35   $17.35   $17.35   $17.35       $18.22            $18.22          Z9405

97535    Congregate Residential Support                         1                  Hour                                            $12.50   $12.50   $12.50   $12.50   $12.50   $12.50   $12.50   $12.50   $12.81   $12.81   $12.81   $12.81   $12.81   $12.85   $13.45   $13.45       $14.80            $14.80          Z8551

S5136    Consumer Directed Companion Services        NOVA       1, 2, 3,5,6        Hour                                                                                                                                      $10.00   $10.10   $10.10   $10.10   $10.61   $10.82       $10.82            $10.82          NONE

S5136    Consumer Directed Companion Services        ROS        1, 2, 3,5,6        Hour                                                                                                                                      $7.75    $7.80    $7.80    $7.80    $8.19    $8.35        $8.35             $8.35           NONE

S5126    Consumer Directed Personal                  NOVA       1, 2, 3, 5         Hour                                                                                         $10.10   $10.10   $10.10   $10.10   $10.10   $10.10   $10.10   $10.10   $10.10   $10.61   $10.82       $10.82            $10.82          Y0078
         Assistance/Attendant Care
         Consumer Directed Personal
S5126                                                ROS        1, 2, 3, 5         Hour                                                                                         $6.00    $6.00    $6.00    $6.00    $7.75    $7.75    $7.80    $7.80    $7.80    $8.19    $8.35        $8.35             $8.35           Y0078
         Assistance/Attendant Care

S5150    Consumer-Directed Respite Services          NOVA       1, 2, 3, 5         Hour                                                                                                                                      $10.10   $10.10   $10.10   $10.10   $10.61   $10.82       $10.82            $10.82          Y0064

S5150    Consumer-Directed Respite Services          ROS        1, 2, 3, 5         Hour                                                                                                                                      $7.75    $7.80    $7.80    $7.80    $8.19    $8.35        $8.35             $8.35           Y0064

H2011    Crisis Stabilization - Intervention                    1, 2               Hour                                                                                                           $81.00   $81.00   $81.00   $81.00   $81.00   $81.00   $81.28   $85.05   $85.05       $89.30            $89.30          Z8999

H0040    Crisis Stabilization - Supervision                     1, 2               Hour                                                                                                           $22.00   $22.00   $22.00   $22.00   $22.00   $22.00   $22.08   $23.10   $23.10       $24.26            $24.26          Z8899
         Day Support, High Intensity, Center and Non
97537                                                           1, 2, 6            Unit*                                           $32.50   $32.50   $32.50   $32.50   $32.50   $32.50   $32.50   $34.15   $34.15   $34.15   $34.15   $34.15   $34.15   $34.27   $35.86   $35.86       $37.65            $37.65          Z8557
         Center Based
         Day Support, Regular Intensity, Center and Non
97537                                                           1, 2, 6            Unit                                            $20.00   $20.00   $22.50   $22.50   $22.50   $22.50   $22.50   $23.99   $23.99   $23.99   $23.99   $23.99   $23.99   $24.07   $25.19   $25.19       $26.45            $26.45          Z8556
         Center Based
         Employee Management Training/Consumer
S5109                                                   NOVA    1, 2, 3,5,6        Unit                                                                                                                             $208.00 $208.00 $208.00 $208.00 $208.73 $218.40 $218.40            $218.40           $218.40         Y0063
         Training
         Employee Management Training/Consumer
S5109                                                   ROS     1, 2, 3,5,6        Unit                                                                                                                             $160.00 $160.00 $160.00 $160.00 $160.56 $168.00 $168.00            $168.00           $168.00         Y0066
         Training
                                                                              Reimb at Cost,
S5165    Environmental Modifications                            1, 2, 4                                                                                       IC       IC       IC       IC       IC       IC       IC       IC       IC       IC       IC       IC       IC           IC                IC
                                                                              $5,000 max/yr
S5111    Family Care Giver Training                             2                  Hour                                                                                                                    $42.50   $42.50   $42.50   $42.50   $42.50   $42.65   $44.63   $44.63       $46.86            $46.86          Y0077




                                                                                                                                                 b4da23cf-8c7e-4e84-b9c0-ff7abc2371ec.xls
                                                      Northern                                                                                                                                                                                                                                           January 1st 2007
                                                      Va                                                                                                                                                                                                                                                  Appropriations
                                                                 Waivers                                                                                                                                                                                                  2006 after
                                                      (NOVA)                                                                                                                                                                                                                             July 1st 2006     Act (effects
National                                                         (See                          1982-                                                                                                                                                                       May Fist                                       Local
         Code Description                             and Rest                    Unit                  1989     1990     1991     1992     1993       1994    1995     1996     1997     1998     1999     2000     2001     2002     2003     2004     2005     2006                  Appropriations   adult day health
Code                                                  of State
                                                                 Index at                       88                                                                                                                                                                         Increase                                       code
                                                                                                                                                                                                                                                                                              Act         only, catch up
                                                      (ROS)      Bottom)                                                                                                                                                                                                    (KKK)
                                                                                                                                                                                                                                                                                                          with a personal
                                                      rates                                                                                                                                                                                                                                               care increase)

H2014    In-Home Residential Support                             1, 2             Hour                                                                                                                                       $18.00   $18.00   $18.00   $18.06   $18.90   $18.90       $19.85            $19.85          Z8595

S5116    Management Training                          NOVA       1, 2, 3,5,6      Hour                                                                                                   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.09   $27.30   $27.30       $27.30            $27.30          Z9568

S5116    Management Training                          ROS        1, 2, 3,5,6      Hour                                                                                                   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.00   $20.07   $21.00   $21.00       $21.00            $21.00          Z9568

T1019    Personal Care                                NOVA       1, 2, 3, 4       Hour        $7.00    $8.50    $8.50    $9.50    $11.00   $11.00    $11.00   $11.00   $11.50   $11.50   $11.50   $12.50   $13.25   $13.25   $13.25   $13.25   $13.38   $13.38   $14.05   $14.33       $14.33            $14.33          Z4036

T1019    Personal Care                                ROS        1, 2, 3, 4       Hour        $7.00    $8.00    $8.00    $8.00    $9.00    $9.00     $9.00    $9.00    $9.50    $9.50    $9.50    $10.50   $10.50   $11.25   $11.25   $11.25   $11.36   $11.36   $11.93   $12.17       $12.17            $12.17          Z4036

T1019    Personal Care AIDS Waiver                    NOVA       5                Hour                                   $14.25   $14.25   $14.25    $14.25   $14.25   $14.25   $14.25   $14.25   $14.25   $14.25   $14.25   $14.25   $14.25   $14.39   $14.39   $15.11   $15.41       $15.41            $15.41          Z4035

T1019    Personal Care AIDS Waiver                    ROS        5                Hour                                   $12.55   $12.55   $12.55    $12.55   $12.55   $12.55   $12.55   $12.55   $12.55   $12.55   $12.55   $12.55   $12.55   $12.68   $12.68   $13.31   $13.58       $13.58            $13.58          Z4035

G0238    Personal Care/Respiratory Therapist          NOVA       4                Hour                                                                                 $18.00   $18.00   $18.00   $18.00   $18.00   $18.00   $18.00   $18.00   $18.18   $18.18   $19.09   $19.47       $19.47            $19.47          Z9490

G0238    Personal Care/Respiratory Therapist          ROS        4                Hour                                                                                 $15.00   $15.00   $15.00   $15.00   $15.00   $15.00   $15.00   $15.00   $15.15   $15.15   $15.91   $16.23       $16.23            $16.23          Z9490
         Personal Emergency Response System (PERS)
S5185                                                 NOVA       1, 2, 3         Month                                                                                                                                       $59.00   $59.00   $59.00   $59.00   $59.00   $59.00       $59.00            $59.00          Y0074
         and Med Monitoring
         Personal Emergency Response System (PERS)
S5185                                                 ROS        1, 2, 3         Month                                                                                                                                       $50.00   $50.00   $50.00   $50.00   $50.00   $50.00       $50.00            $50.00          Y0074
         and Med Monitoring
         Personal Emergency Response System (PERS)
S5160                                                 NOVA       1, 2, 3       Installation                                                                                                                                  $88.50   $88.50   $88.50   $88.50   $88.50   $88.50       $88.50            $88.50          Y0072
         and Med Monitoring Installation
         Personal Emergency Response System (PERS)
S5160                                                 ROS        1, 2, 3       Installation                                                                                                                                  $75.00   $75.00   $75.00   $75.00   $75.00   $75.00       $75.00            $75.00          Y0072
         and Med Monitoring Installation
         Personal Emergency Response System (PERS)
S5160                                                 NOVA       1, 2, 3       Installation                                                                                                                                  $59.00   $59.00   $59.00   $59.21   $59.21   $59.21       $59.21            $59.21          Y0071
         Installation
         Personal Emergency Response System (PERS)
S5160                                                 ROS        1, 2, 3       Installation                                                                                                                                  $50.00   $50.00   $50.00   $50.18   $50.18   $50.18       $50.18            $50.18          Y0071
         Installation
         Personal Emergency Response System (PERS)
S5161                                                 NOVA       1, 2, 3         Month                                                                                                                                       $35.40   $35.40   $35.40   $35.40   $35.40   $35.40       $35.40            $35.40          Y0073
         Monitoring
         Personal Emergency Response System (PERS)
S5161                                                 ROS        1, 2, 3         Month                                                                                                                                       $30.00   $30.00   $30.00   $30.00   $30.00   $30.00       $30.00            $30.00          Y0073
         Monitoring
         Personal Emergency Response System (PERS)                             Contact (15
H2021                                                 NOVA       1, 2, 3                                                                                                                                                     $13.00   $13.00   $13.00   $13.00   $13.00   $13.00       $13.00            $13.00          Y0076
         Nursing Services LPN                                                   Minutes)
         Personal Emergency Response System (PERS)                             Contact (15
H2021                                                 ROS        1, 2, 3                                                                                                                                                     $10.25   $10.25   $10.25   $10.25   $10.25   $10.25       $10.25            $10.25          Y0076
         Nursing Services LPN                                                   Minutes)
         Personal Emergency Response System (PERS)                             Contact (15
H2021                                                 ROS        1, 2, 3                                                                                                                                                     $12.25   $12.25   $12.25   $12.25   $12.25   $12.25       $12.25            $12.25          Y0075
         Nursing Services RN                                                    Minutes)
         Personal Emergency Response System (PERS)                             Contact (15
H2021                                                 NOVA       1, 2, 3                                                                                                                                                     $15.00   $15.00   $15.00   $15.00   $15.00   $15.00       $15.00            $15.00          Y0075
         Nursing Services RN                                                    Minutes)
H2025    Pre-vocational Services, High Intensity                 1, 2, 6          Unit                                                                                                                                                $34.15   $34.15   $34.27   $35.86   $35.86       $37.65            $37.65          NONE

H2025    Pre-vocational Services, Regular Intensity              1, 2, 6          Unit                                                                                                                                                $23.99   $23.99   $24.07   $25.19   $25.19       $26.45            $26.45          NONE

T1003    Private Duty Nursing Services/LPN            NOVA       4, 5             Hour        $23.03   $23.03   $23.03   $23.03   $23.03   $23.03    $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00       $27.30            $27.30          Z9402

T1003    Private Duty Nursing Services/LPN            ROS        4, 5             Hour        $19.00   $19.00   $19.00   $19.00   $19.00   $19.00    $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45       $22.52            $22.52          Z9402

T1002    Private Duty Nursing Services/RN             ROS        4, 5             Hour        $21.60   $21.60   $21.60   $21.60   $21.60   $21.60    $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70       $25.94            $25.94          Z9401

T1002    Private Duty Nursing Services/RN             NOVA       4, 5             Hour        $21.60   $21.60   $21.60   $21.60   $21.60   $21.60    $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00       $31.50            $31.50          Z9401

T1028    Reassessment Visit                           NOVA       1, 2, 3, 5       Visit                                                                                                                                      $105.00 $105.00 $105.00 $105.37 $110.25 $110.25           $110.25           $110.25         Z9564

T1028    Reassessment Visit                           ROS        1, 2, 3, 5       Visit                                                                                                                                      $80.00   $80.00   $80.00   $80.28   $84.00   $84.00       $84.00            $84.00          Z9564

S9125    Respite - Aide                               NOVA       4                Hour                                                               $9.60    $9.60    $9.60    $9.60    $9.60    $9.60    $9.60    $10.35   $10.35   $10.35   $10.35   $10.35   $10.87   $11.09       $11.09            $11.09          Z9425

S9125    Respite - Aide                               ROS        4                Hour                                                               $8.30    $8.30    $8.30    $8.30    $8.30    $8.30    $8.30    $9.05    $9.05    $9.05    $9.05    $9.05    $9.50    $9.69        $9.69             $9.69           Z9425

S9125    Respite Care/LPN                             NOVA       3, 4, 5          Hour        $23.50   $23.50   $23.50   $26.00   $26.00   $26.00    $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00       $27.30            $27.30          Z9404

S9125    Respite Care/LPN                             ROS        3, 4, 5          Hour        $19.00   $19.00   $19.00   $19.00   $19.00   $19.00    $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45       $22.52            $22.52          Z9404

S9125    Respite Care/RN                              NOVA       4, 5             Hour        $28.00   $28.00   $28.00   $30.00   $30.00   $30.00    $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00       $31.50            $31.50          Z9403

S9125    Respite Care/RN                              ROS        4, 5             Hour        $21.60   $21.60   $21.60   $21.60   $21.60   $21.60    $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70       $25.94            $25.94          Z9403

T1005    Respite Care-AIDS Waiver                     NOVA       5                Hour                                   $14.25   $14.25   $14.25    $14.25   $14.25   $14.25   $14.25   $14.25   $14.25   $14.25   $14.25   $14.25   $14.25   $14.39   $14.39   $15.11   $15.41       $15.41            $15.41          Z9421

T1005    Respite Care-AIDS Waiver                     ROS        5                Hour                                   $12.55   $12.55   $12.55    $12.55   $12.55   $12.55   $12.55   $12.55   $12.55   $12.55   $12.55   $12.55   $12.55   $12.68   $12.68   $13.31   $13.58       $13.58            $13.58          Z9421

T1005    Respite Services                             NOVA       1, 2, 3, 4       Hour                          $11.00   $11.00   $11.00   $11.00    $11.00   $11.00   $11.50   $11.50   $11.50   $12.50   $13.25   $13.25   $13.25   $13.25   $13.38   $13.38   $14.05   $14.33       $14.33            $14.33          Z9421




                                                                                                                                                   b4da23cf-8c7e-4e84-b9c0-ff7abc2371ec.xls
                                                          Northern                                                                                                                                                                                                                                             January 1st 2007
                                                          Va                                                                                                                                                                                                                                                    Appropriations
                                                                      Waivers                                                                                                                                                                                                   2006 after
                                                          (NOVA)                                                                                                                                                                                                                               July 1st 2006     Act (effects
National                                                              (See                        1982-                                                                                                                                                                          May Fist                                       Local
         Code Description                                 and Rest                    Unit                  1989      1990      1991     1992     1993       1994    1995     1996     1997     1998     1999     2000     2001     2002     2003     2004     2005     2006                  Appropriations   adult day health
Code                                                      of State
                                                                      Index at                     88                                                                                                                                                                            Increase                                       code
                                                                                                                                                                                                                                                                                                    Act         only, catch up
                                                          (ROS)       Bottom)                                                                                                                                                                                                     (KKK)
                                                                                                                                                                                                                                                                                                                with a personal
                                                          rates                                                                                                                                                                                                                                                 care increase)

T1005       Respite Services                              ROS         1, 2, 3, 4      Hour                           $9.00     $9.00    $9.00    $9.00     $9.00    $9.00    $9.50    $9.50    $9.50    $10.50   $11.25   $11.25   $11.25   $11.25   $11.36   $11.36   $11.93   $12.17       $12.17            $12.17          Z9421

T1003       Skilled Nursing Services/LPN                  NOVA        1, 2            Hour       $23.03    $23.03    $23.03    $23.03   $23.03   $23.03    $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.00   $26.09   $27.30   $27.30       $27.30            $27.30          Z9402

T1003       Skilled Nursing Services/LPN                  ROS         1, 2            Hour       $19.00    $19.00    $19.00    $19.00   $19.00   $19.00    $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.45   $21.53   $22.52   $22.52       $22.52            $22.52          Z9402

T1002       Skilled Nursing Services/RN                   NOVA        1, 2            Hour       $26.23    $26.23    $26.23    $26.23   $26.23   $26.23    $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.00   $30.11   $31.50   $31.50       $31.50            $31.50          Z9401

T1002       Skilled Nursing Services/RN                   ROS         1, 2            Hour       $21.60    $21.60    $21.60    $21.60   $21.60   $21.60    $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.70   $24.79   $25.94   $25.94       $25.94            $25.94          Z9401

H2024       Supported Employment, Enclave/Work Crew                   1, 2            Unit*                                                                                  $32.50   $32.50   $32.50   $32.50   $32.50   $32.50   $32.50   $32.50   $32.50   $32.61   $34.13   $34.13       $35.84            $35.84          Z8598
            Supported Employment, Individual Placed
H2023                                                                 1, 2            Hour                                                                                   $16.00   $16.00   $16.00   $16.00   $16.00   $16.00   $16.00   $16.00   $16.00   $16.06   $16.80   $16.80       $17.64            $17.64          Z8597
            Prevocational
T1017       Targeted Case Management                                  State Plan     Month                                              $175.40 $175.40 $175.40 $175.40 $175.40 $175.40 $175.40 $175.40 $175.40 $175.40 $260.00 $260.00 $260.00 $260.00 $326.50 $326.50                      $326.50           $326.50         Z8545

97139       Therapeutic Consultation                                  1, 2            Hour                                              $50.00   $50.00    $50.00   $50.00   $50.00   $50.00   $50.00   $50.00   $50.00   $50.00   $50.00   $50.00   $50.00   $50.18   $52.50   $52.50       $55.13            $55.13          Z8565


IC = Individual Consideration                                         1= Mental Retardation
                                                                      2 = Individuals and Families Development Disability Services
                                                                      3=Elderly and Disabled with Consumer Direction
                                                                      4 = Technology Assisted
                                                                      5 = AIDS
                                                                      6 = Day Support


* One Unit=1 to 3.9 Hours. Two Units=4 to 6.9 Hours. Three Units=7 or more hours per day.




                                                                                                                                                         b4da23cf-8c7e-4e84-b9c0-ff7abc2371ec.xls

								
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